Images in Clinical Medicine
Calcium Oxalate Crystals in Ethylene Glycol Toxicity
Mohamad Hanouneh, Teresa K. Chen
N Engl J Med 2017; 377: 1467
An 80-year-old man with a remote history of alcohol-use disorder presented to the emergency department with altered mental status after a fall at home. He was somnolent and unable to provide any further history. Serum studies revealed a creatinine level of 2.4 mg per deciliter (212 μmol per liter; reference range, 0....

Images in Clinical Medicine
Pulmonary Foreign-Body Granulomatosis
Dustin A. Staloch, J. Stephen Hedley
N Engl J Med 2017; 377: 1273
A 31-year-old woman who was receiving long-term total parenteral nutrition after having undergone Roux-en-Y gastric bypass that was complicated by small-bowel resection presented to the pulmonology clinic with exertional dyspnea that had progressed over the course of 1 year. She had normal oxygen saturation while breathing ambient air and was...

IMAGES IN CLINICAL MEDICINE
Eosinophilic Bronchitis
Yanhong Ren, M.D., Ph.D., and Huaping Dai, M.D.
N Engl J Med 2017; 377:873
DOI: 10.1056/NEJMicm1616156
A 43-year-old woman presented with an 8-month history of progressively worsening nonproductive cough. She had been treated with antibiotic agents for presumed bronchitis, but her cough continued to worsen. Her vital signs were normal, the pulmonary examination was notable for wheezing in both lungs, and the white-cell c...

Images in Clinical Medicine
Left-Middle-Lobe Pneumonia
Ling Yuan Kong, Yves Longtin
N Engl J Med 2017; 377: e8
DOI:10.1056/NEJMicm1700661
A 34-year-old man presented to the emergency department with a 5-day history of fever, cough, and dyspnea. He had received a diagnosis of situs inversus when he was 2 years of age, after a chest radiograph had been obtained in order to evaluate a cough. Physical examination was notable for heart sounds in the right side of his chest and...

Chest X-Rays: 16 Subtle But Key Findings You Need to Know
Lars Grimm, MD, MHS | August 2, 2017
The chest radiograph is one of the views most commonly ordered by clinicians, and it is frequently first viewed by non-radiologists. Although many disease processes are obvious at first glance on chest radiographs, clinicians must be careful not to miss more subtle findings.
This image shows a solitary pulmonary nodule (circle) in the left midlung.
Image courtesy of Lars Grimm, ...